District Attorney’s Restitution Worksheet
**Pursuant to 137.106 (1) & 137.103 (4)**
Submit to the Court 48 Hours Prior to Sentencing
State of Oregon vs. Case No.
Victim Information Restitution
Count # Name Address Claim/Account # Type Total Ow ed
1 a b c d
2 a b c d
3 a b c d
4 a b c d
5 a b c d
6 a b c d
7 a b c d
8 a b c d
9 a b c d
10 a b c d
11 a b c d
12 a b c d
13 a b c d
137.103 (4) - Four Types of Victims
(a) The person against whom the defendant committed the criminal offense, if the court determines that the person suffered economic damages as a result of the
(b) Any person not described in (a) of this subsection whom the court determines has suffered economic damages as a result of the defendant’s criminal activity.
(c) The Criminal Injuries Compensation account, if it has expended moneys on behalf of a victim described in paragraph (a) of this section.
(d) An insurance carrier, if it has expended moneys on behalf of victim described in paragraph (a) of this section.
Note to Court Clerk: This is a confidential document. After entry in OJIN it must be sealed.